Smoking affects the oral glucose tolerance test profile and the relationship between glucose and HbA1c in gestational diabetes mellitus.

AIMS: Current smokers in the general population have a lower 2 h plasma glucose after an oral glucose tolerance test (OGTT) and a higher HbA1c than non-smokers, but the relationships between OGTT/HbA1c and smoking status have not been addressed in pregnancy. We analysed glycaemic measurements in women with gestational diabetes mellitus in relation to smoking status. METHODS: We performed a review of the prospectively collected database of the diabetes and pregnancy clinic. We included women with gestational diabetes mellitus and a singleton pregnancy who delivered between 1986 and 2006. Bivariate and multivariate analyses were used to evaluate patient characteristics in relation to smoking status. RESULTS: A total of 2361 women met the inclusion criteria: 556 (23.5%) were active smokers, 266 (11.3%) quit during pregnancy and 1539 (65.2%) were non-smokers. Most baseline characteristics were similar across groups. Diagnostic OGTT was performed at a gestational age of [median (25th, 75(th) centiles)] 29 weeks (26, 33). Women who smoked at the beginning of pregnancy had a higher 1-h plasma glucose than non-smokers [11.8 (11, 12.7), 11.6 (11, 12.6) and 11.5 (10.8, 12.5) mmol/l, for active smokers, those who quit during pregnancy and non-smokers, respectively, P < 0.001] and a lower 3-h plasma glucose [7.3 (5.9, 8.4), 7.6 (6.4, 8.7) and 8.0 (6.8, 9.0) mmol/l, respectively, P < 0.001]. HbA1c was higher in women who smoked at the beginning of pregnancy. Multiple regression analysis confirmed the independent association of smoking status with HbA1c and OGTT plasma glucose. CONCLUSIONS: In women with gestational diabetes mellitus who smoke at the beginning of pregnancy, the shape of the OGTT is consistent with accelerated glucose absorption, and HbA1c is higher than expected for glycaemic values.

Sphinganine and sphingosine levels and ratio in urine and blood samples from a Catalonian population, Spain.

Fumonisins occur mainly in maize and they produce alterations on sphingolipid metabolism, unbalancing the sphinganine (Sa)/sphingosine (So) ratio. This alteration has been proposed as a biomarker of fumonisin exposure. The objective of this study was to establish the urinary and plasmatic levels of Sa, So as well as the ratio Sa/So from a sample of the Catalonian (Spain) population exposed to fumonisins at low levels. Firstly, plasma and urinary Sa and So levels and the ratio Sa/So were compared between two population groups, and later urinary Sa and So levels from corn food consumers and a control group were monitored for 2 weeks under controlled intake of corn foods. Sa and So levels were determined in urine and blood samples using validated methods using HPLC with fluorescence detection. Significant differences were not found in urine samples when Sa/So ratios were compared from corn food consumers and non-consumers, while significant differences were found in urine and plasma samples, but evidence of the mechanism of action of fumonisins was not apparent. Through a time-course study we have narrowed down the day in which the maximum alteration of Sa/So ratio should be expected in humans. This paper reports some useful information to improve the design of studies to validate the ratio Sa/So as a possible biomarker of fumonisin exposure.

Cambios en el perfil del paciente diabético hospitalizado en una sala de cirugía vascular y de los procedimientos quirúrgicos utilizados en 1985 y 2007 / Changes of the in-hospital diabetic patient profile in the employed in a vascular surgery department and surgical procedures between 1985 and 2007

Objetivos: 1. Conocer las características de los pacientes con piediabético hospitalizados en cirugía vascular durante los años 1985y 2007, los procedimientos quirúrgicos utilizados, la estancia mediay la mortalidad, y 2. Conocer el grado de control de la diabetes y losfactores de riesgo asociados en los mismos pacientes en 2007.Material y métodos: Se analizaron datos de la diabetes (tipo,tiempo de evolución, tratamiento y complicaciones), factores deriesgo, procedimientos quirúrgicos, estancia media y mortalidad enlos años 1985 y 2007. En 2007 se valoraron además: hemoglobinaglucosilada (HbA1c), perfil lipídico y presión arterial (PA). Resultados:Se evaluaron 162 pacientes (91 en 1985, 71 en 2007). Laprevalencia de complicaciones microangiopáticas, el número de fumadoresy los pacientes en tratamiento con insulina fueron superioresen 1985. La edad y prevalencia de hipertensión y dislipemiafueron mayores en 2007. La distribución por sexos y duración de ladiabetes fueron similares. En 1985 se practicaron más amputaciones,y en 2007 más cirugía conservadora, asociada o no a amputaciónmenor, y menos amputaciones, sobre todo mayores. En 2007no se practicaron simpatectomías lumbares, frecuentes en 1985. Lamortalidad y la estancia media fueron inferiores en 2007, pero sóloun 36% de pacientes tenía una HbA1c <7%, un 24% presentaba PAinferior al objetivo y un 29% cumplía objetivos lipídicos. Conclusiones:Los sujetos ingresados en 2007 presentan menos complicacionesde la diabetes que los de 1985 con el mismo tiempo deevolución. Ya no se realizan simpatectomías lumbares, se han reducidolas amputaciones, sobre todo mayores, y se realiza más cirugíarevascularizadora. En 2007 el grado de control de la diabetes, la PAy los lípidos es subóptimo(AU)

Objectives: To know: 1) The features of patients hospitalised fordiabetic foot in the department of vascular surgery, the years 1985and 2007, surgical procedures used, average stay and mortality.2) Metabolic control and associated cardiovascular risk factors of thesame patients in 2007. Material and methods: Data related todiabetes (type, time evolution, treatment, complications), other riskfactors, surgical procedures, average stay and mortality in the years1985 and 2007, were registered. In 2007 other parameters werealso registered: HbA1c, lipid profile and blood pressure. Results: Atotal of 162 diabetic patients were evaluated (91 in 1985 and 71 in2007). The prevalence of microangiopathic complications, currentsmokers and number of patients treated with insulin were higher in1985. Age, prevalence of hypertension and dyslipidemia were higherin 2007. Sex distribution and diabetes duration were similar. In1985 more amputations were carried out. In 2007 more conservativesurgery associated or not with minor amputation was executed,with less number of amputations (especially major). In 2007, lumbarsympathectomy was not performed, whereas it was frequent in1985. Mortality and average stay were reduced in 2007, but only 36% of subjects presented HbA1c <7%, only 24% presented bloodpressure below goals and only 29% had lipid profile below goals.Conclusions: Patients hospitalised in 1987 had more complicationsof diabetes than those hospitalised in 2007, with the sametime of evolution. Nowadays, lumbar sympathectomy has been abandoned,amputations have been reduced (especially major amputations)and more revascularization surgery is performed. In 2007,control of diabetes, lipids and blood pressure are suboptimal(AU)